The Centers for Disease Control and Prevention (CDC) has been conducting a national survey of Maternity Practice in Infant Nutrition and Care (mPINC) for over a decade. The survey measures hospital policies and practices that may affect infant feeding, skills of the maternity care team, education provided by the maternity care team, and post discharge support. Most birthing facilities in the United States and territories are invited to participate. In 2020, the response rate was 75% (2,103 of 2,820 eligible hospitals participated) (CDC, 2021). It is important to note that some specialized birthing facilities such as the one at my institution are because our births are infants with complex medical conditions. However, with that caveat, the report provides an opportunity to see how birthing facilities are performing in each state.

Nationally, the overall score for birth hospitals has increased to 81 out of a total of 100 points (CDC, 2021). However, that score is still disappointing. Importantly, there are vast geographic differences and even more disparities if you examine individual hospitals. Unfortunately, individual birthing facilities survey results are not publicly available.

It is very concerning that supplementation rates in birthing facilities remain alarming high. Only 38% of hospitals nationally had an ideal response where few infants recieve formula and less than half of hospitals (48%) pay a fair market price for infant formula (CDC, 2021). Only 33% of hospitals report that they have 100% of all elements present in their policies to protect the effective establishment of breastfeeding only 32% reported ideal practices where routine newborn exams, procedures, and care occur in the mother's room (CDC).

There is a critical window to establish milk supply (Spatz, 2020) and it is evident through the national mPINC data that families are not receiving the optimal evidence-based care and interventions to ensure a robust milk supply and promote breastfeeding. Development of a copious milk supply early frequent stimulation and emptying of the breast to convert from lactogenesis I (secretory differentiation) to lactogenesis II (secretory activation). With the abundant formula supplementation that is noted in the mPINC reports and the lack of infants being in the room continuously, the impact on development of milk supply is clear. If any health care provider is going to say the "S" word (supplementation) to a parent, in the same sentence, they must say the "P" word (pump). If the infant is becoming full on formula, the stimulation and effective emptying of the breast is compromised. Research from my hospital where only critically ill children are born, show how significant the impact of early frequent breast stimulation and emptying is for development of milk supply (Froh et al., 2021).

We know that the COVID-19 pandemic has negatively affected birth and breastfeeding practices in the United States and globally, so there is concern that birthing hospital practices may continue to decline in future years. If you work at a birthing facility, I urge you to find out your score and to examine areas of opportunity to improve the care you provide to childbearing families. Nursing leaders at all birthing hospitals should consider conducting at least one quality improvement project on human milk and breastfeeding on an annual basis. We are not going to see a dramatic increase in breastfeeding exclusivity and duration rates in the United States unless our birthing facilities step up and take action to improve practices to protect milk supply during the critical window of opportunity.

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